Provider Demographics
NPI:1669717096
Name:KRESTIN, LUZ AMPARO (DDS)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:AMPARO
Last Name:KRESTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MITCHELL PL
Mailing Address - Street 2:STE.102
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4342
Mailing Address - Country:US
Mailing Address - Phone:914-683-5203
Mailing Address - Fax:914-289-0846
Practice Address - Street 1:10 MITCHELL PL
Practice Address - Street 2:STE.102
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4342
Practice Address - Country:US
Practice Address - Phone:914-683-5203
Practice Address - Fax:914-289-0846
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0432801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice